Although health disparities among rural children are widely documented, rural Appalachian American children bear an undue burden of psychological, socioeconomic, and environmental factors known to attribute to these health disparities. Parents of children in Appalachian communities report a greater prevalence of behavioral problems in their children of as compared to national parental reports. Moreover, Appalachian communities are exposed to environmental toxicants known to cause deficits in neurodevelopment. The relationship among psychosocial and environmental influences on children's neurodevelopment remains unclear. Thus, we hypothesize that exposure to airborne neurotoxicants are associated with neurobehavioral deficits including measures of cognition, attention, memory, neuromotor function in an underserved Appalachian American pediatric population and this association is modified by socioeconomic conditions, rearing environment, and other factors. In order to test the hypothesis, the following specific aims will be accomplished: Specific Aim 1: Assess the overall context in which childhood environmental exposure occurs, including socioeconomic, familial, nutrition, and other factors, in order to examine the dynamic process of environmental health in rural underserved communities. Specific Aim 2: Determine if children exposed to airborne neurotoxicants are at increased risk for deficits in neurodevelopment using a battery of well-validated assessments. Our project is a novel, community-based participatory research project that will for the first time evaluate multiple risk factors believed to influence Appalachian child health using sensitive biological and behavioral markers. Ultimately, this project will lead to the identification of the key multiple rik exposures for targeted public health interventions for rural, underserved Appalachian Americans. Given the unique susceptibility of children to neurotoxicant exposure in combination with psychosocial factors, we anticipate the results of this study to have a major impact on the community, national policy, and regulatory changes and broad implications for addressing health disparities in Appalachian Americans. PUBLIC HEALTH RELEVANCE: Rural Appalachian Americans suffer poorer socio-economic conditions, including higher unemployment, lower educational achievement, lower per capita income, compared to non- Appalachian Americans, and experience an undue burden of environmental exposures known to negatively influence neurodevelopment in children. The purpose of this project is to explore these risk factors and their relationship to neurodevelopment in a cohort of rural Appalachian school-aged children.